Provider Demographics
NPI:1750634481
Name:ALTERNATIVE WELLNESS & CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:ALTERNATIVE WELLNESS & CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WOMBOLDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:563-265-7233
Mailing Address - Street 1:1721 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2644
Mailing Address - Country:US
Mailing Address - Phone:563-242-5515
Mailing Address - Fax:563-242-0765
Practice Address - Street 1:1721 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2644
Practice Address - Country:US
Practice Address - Phone:563-242-5515
Practice Address - Fax:563-242-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty